Clinical Clerkship in Medical Respiratory Diseases

Credits: 4.00 CREDITS (Clinical Elective)
Sites: BWH
Directors: Cockrill, Barbara Ann
Prerequisites: HMS Principal Clinical Experience (Core Clinical Clerkships) or equivalent
Offered: Full time for one month. Not offered in May and July.
Open to Exclerks: Yes (may be restricted for international students)
During this clerkship, the medical student will be exposed to several aspects of consultative pulmonary medicine including both inpatient and outpatient experiences. Central to the rotation, the student will be an active member of the inpatient consult team composed of a PCCM attending and fellow as well as occasional Internal Medicine residents. This team is responsible for providing diagnostic and therapeutic recommendations for patients with a variety of respiratory issues as well as assisting in ventilator management of patients in non-medical intensive care units.

The medical student will evaluate patients alone and then with the team, allowing for instruction on history taking and physical diagnosis. Subsequently, the student will be involved in formulating a series of recommendations for the consulting team. Through this experience, the student will be exposed to a wide variety of inpatient respiratory issues and become familiar with the role of the consultant. The daily experience includes morning rounds including didactic teaching from both the attending and fellow, regularly scheduled bronchoscopies, and consultation on new patients. Afternoons afford time for the student to participate in pulmonary clinic with particular emphasis on urgent outpatient consultation. In addition to these experiences, the student will gain great familiarity with the interpretation of chest radiographs, chest CT scans and pulmonary function tests.

Students will have the opportunity to attend a variety of conferences through the PCCM division at Brigham and Women’s Hospital. These include weekly Pulmonary Grand Rounds and Radiology/Pathology Case Conferences. In addition, there are many research as well as sub-specialty conferences (e.g. lung transplant rounds) which the student may attend if interested.

There is no call on this rotation.
Learning Goals:
Assessment of common inpatient pulmonary issues including unexplained hypoxemia, diffuse infiltrates, lung nodules/masses, respiratory failure and pulmonary hypertension.
Assessment of common outpatient pulmonary issues including dyspnea of unclear origin, cough, poorly controlled asthma and COPD, lung nodules and interstitial infiltrates.
Interpretation of pulmonary function tests.
Interpretation of chest radiographs.
Incorporation of Basic Science Content and Evidence-Based Medicine:
For each consult, the team will review and discuss the most current literature relevant to the patient’s presenting problem. On a regular basis, the team will provide this literature to the consulting team with an effort to make evidence-based recommendations. In addition, the medical student will be asked to give at least two talks during the clerkship. These will usually be a review of a patient’s case and then a discussion of the particular disease or pathophysiologic process with an emphasis on reviewing the relevant literature.

Many of the attendings on this service are active bench scientists who incorporate basic science content in the daily team didactic sessions. In addition, our Pulmonary Grand Rounds are often basic as well as clinical and translational science presentations. These conferences occur weekly and the student will attend these with the team.
Students will be evaluated by all attendings with whom they work during the clerkship with input from the PCCM fellow on service as well. History taking, physical diagnosis as well as knowledge base will be assessed. In addition, the student's ability to communicate with patients and consulting teams will be incorporated into the evaluation. Finally, the student's presentations (two at a minimum) will be assessed and factor into the overall grade.
Grade Criteria:
High Honors:
Ability of the student to consistently perform on a level exceeding expectations for someone at their degree of training. This includes history taking which misses very few details, comprehensive physical diagnosis with particular skill in obtaining pulmonary findings, concise and complete oral presentations and notes as well as an exemplary knowledge base. Students receiving high honors will demonstrate the ability to communicate clearly with consulting teams as well as develop strong relationships with their patients. Additionally, this grade requires student presentations which are outstanding in the estimation of the attending.
Ability of the student to consistently perform at or above the level of someone at their degree of training. This includes an outstanding performance on at least three aspects of their evaluation include history taking, physicial diagnosis, fund of knowledge, communication skills, oral presentations and note writing.
Ability of the student to perform at or near the expected level of someone at their degree of training with respect to history taking, physicial diagnosis, fund of knowledge, communication skills, oral presentations and note writing.
Inability to perform at the expected level of someone at their degree of training with respect to more than one of the following: history taking, physicial diagnosis, fund of knowledge, oral presentations and note writing.
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